Laser Resurfacing

Fractionated CO2 Laser Technology

Dr. De Silva offers the latest laser technology for wrinkles, sun spots, discoloration, and skin tightening. Fractionated CO2 technology differs from the previous technology as it is a single treatment that delivers more dramatic results than older non-ablative lasers. The technology offers significant improvement over traditional carbon dioxide (CO2) lasers because there is no prolonged recovery or redness. The laser treatment must be tailored to the individual depending on their skin types and the degree of facial ageing. Dr. De Silva often uses fractionated CO2 laser resurfacing in conjunction with other facial cosmetic surgery to improve the results. The laser improves the appearance of the skin by reducing lines, wrinkles, sun damage, brown spots, acne scars and improved tone, texture and skin tightening.

Dr. Julian De Silva invests in the latest in technology to offer his patients the most effective and fastest possible recovery. Dr. De Silva has imported the latest state-of-the-art CO2 Fractional Laser from the USA. The fractional CO2 laser penetrates deep into your skin and provides heat to stimulate collagen production, and the second Erbium component of the laser is effective for more superficial rejuvenation and soften the fine lines and remove pigmentation from the top layers of skin. The Cortex laser’s unique design treats the skin with precise control, and can be tailored to a specific problem and allotted downtime. For fine lines and superficial sun damage, a single procedure can produce significant results with a faster recovery.

Dr. De Silva uses a combination of state-of-the-art technology and techniques to enhance skin tightening and reducing recovery time. Dr. De Silva imported a state-of-the-art Combined CO2 and Erbium laser from USA, which works to tighten skin on two separate levels. The CO2 laser targets tightening the deep layers of the skin and the erbium laser targets tightening the superficial layers. Depending on your ethnicity and degree of skin quality the settings are adjusted to ensure maximal tightening with reduced recovery time.

Dr. De Silva utilises new biotherapy treatment to improve your recovery after treatment. Platelet Rich Plasma (PRP) Therapy is at the forefront of new medical and surgical treatments and many professional sports stars have utilized this technology to enhance their recovery following injuries by natural stimulation of the body’s self-repairing mechanisms. PRP utilises your body’s natural reparative mechanisms to trigger faster recovery after surgery and enhance specific treatment results. PRP involves taking a relatively small volume of blood from a vein in your arm, utilizing a high-tech machine to concentrate the PRP (Growth factors) in your blood, then reintroducing the PRP into the areas of the face that have been treated with the laser to boost healing and recovery with your own growth factors. See this link for further information on PRP Technology.

Laser resurfacing of the skin can be uncomfortable with local and topical anaesthesia alone, as most of the sensory nerves of the skin are located superficially where the CO2 laser tightens skin. For some patients Dr. De Silva provides sedation anaesthesia, this results in the laser treatment being both a comfortable and relaxing experience. See this link for further information on Sedation Anaesthesia.

In the past, it was thought that ageing of the face was an inevitable normal process over which we had little control. Scientific research has shown that up to 90% of skin ageing is a consequence of exposure to the sun. Sunlight accelerates the ageing process through photoageing that is preventable through sun avoidance and the use of sun protection agents. The other 10% of skin aginig is considered intrinsic and more difficult to influence. There is cumulative damage to the skin that occurs with sun exposure, the damage may go unnoticed until many years later, and is why it is important to take precautions from the sun from childhood.

What is laser resurfacing used for?

Fractionated CO2 Laser resurfacing may be used to remove or improve the appearance of:

Wrinkles, fine and deep lines in the skin

Pigmentation in the skin, including sun brown spots

Superficial scars caused by acne

skin textures and pores

Specific facial areas: lines that are principally around the eyes or mouth

Depending on the size of the area of the face being treated is a guide to the anaesthesia required. Local anaesthesia with or without sedation is all that is commonly required, general anaesthesia is not usually required. Eye shields or goggles are placed over the eyes to protect them and the laser is passed over the skin, sending out pulses of laser. The treatment takes between 30-60 minutes depending on the facial area and once the treatment is completed, the skin is covered with an antibiotic ointment and a cold compress placed over the area to reduce swelling. All patients are able to go home approximately 30minutes after the procedure.

What type of anaesthesia is required for CO2 laser resurfacing?

Single areas of the face, such as around the eyes or lips, can be treated with local anaesthesia only, a combination of topical numbing creams and local anaesthesia. Treatment of the entire face can be completed with local anaesthesia with or without sedation.

How long does the CO2 laser take to work?

You will see some immediate results from the CO2 laser resurfacing and the final result is at 6 months after treatment. The Cortex combined CO2 and Erbium laser is customised to an individual patient, treatments that are deeper are more effective however associated with more healing and downtime. Your skin heals between 5-days and 2-weeks depending on the depth of the laser resurfacing, and there may be a period of 4 to 6 weeks after that when your skin might be slightly pink. During this period, your skin will feel smoother and looks less blotchy. During the first few weeks you will see fewer lines, less blotchiness, more even colour and more glow.

How long does the CO2 resurfacing laser last?

The laser skin resurfacing lasts for many years, the effectiveness depends on how well you protect your skin from the sun and other factors that including your genetics, ethnicity, smoking, changes in weight, etc. To maintain the appearance of your rejuvenated skin Dr. De Silva recommends you apply sunscreen (of SPF 30 or above) and wear brimmed hats, generally the good effects of the CO2 laser treatment lasts for more than 10 years.

What is the recovery after CO2 fractional laser resurfacing?

Most patients return to full social and professional activities between one and two weeks.

The time needed for healing and recovery after laser resurfacing varies according to the size and depth of the treated area and the patient’s skin type. In general, the younger fresher skin replaces the older sun damaged skin between 1 and 2 weeks. Cold packs and analgesia are used to reduce swelling and discomfort. The skin may occasionally remain red for several weeks, and this can be masked with cosmetic concealer after 1-2 weeks. Some patients may have darkening of the skin at approximately 1-month after surgery, this is temporary and resolves (termed post-inflammatory hyper pigmentation), and can be covered with cosmetic concealer if required. Most patients return to full social and professional activities between one and two weeks.

Care of the treated area of the face while the skin is healing is important and includes:

Rinsing the skin several times a day with cool tap water and a cetaphil skin soap to remove crusting that sometimes occurs.

Perfumes and other cosmetics should be avoided during this time as them may irritate the skin

Laser skin resurfacing is an effective technique for rejuvenating the skin for treating:

Wrinkled or sun-damaged facial skin

“crow’s feet” lines around your eyes and some skin laxity in your lower eyelid area

Fine wrinkling of your eyelid skin

Brown spots or blotchy skin coloring

Acne or chicken pox scars

Superficial facial scars from a past injury

Faster recovery with state-of-the-art Fractional Technology

Faster recovery with bio-technology, PRP

There are some considerations when Dr. De Silva uses laser resurfacing:

The type of laser and surgical technique, needs to be tailored to the individual the extent of the skin ageing, ethnicity and skin pigmentation. Generally fractionated CO2 lasers offer an effective skin rejuvenation while minimizing the potential side effects and offer a fast recovery. Modern day lasers offer faster recovery by treating only a proportion of the skin (termed fractionated), older lasers treated all of the skin surface (termed ablative lasers) were associated with higher risks and longer recovery.

Expectations: resurfacing will only partially improve scars, further treatments may be indicated

Temporary pigmentation can occur and can be treated with skin creams

What is the best skin care after laser skin resurfacing?

After laser treatment the older skin will become dry and peel off, during this time it is important to keep the skin lubricated. To care for the skin after resurfacing:

After laser treatment the skin tends to dry out, apply Vaseline or similar lubricating ointment regularly while the skin is crusting and peeling.

Wash your face regularly with a cetaphil skin soap (simple skin soap with few preservatives) to clean the skn from skin debris and body secretions. Cleansing gently with gauze sponges to clean the skin every 3-4 hours is recommended.

After approximately 10-days the skin will have finished peeling and you can apply a concealer make up to any areas of the redness

Keep using skin moisturisers and cleansers after peeling has completed

Keep using sun protection creams (SPF of 30 or above) for at least 6-months after laser resurfacing to maintain your skin condition

Moisturiser

After laser resurfacing it is important to keep your skin moisturized. I provide my patients with a prescription for bactroban (Mupirocin 2%) ointment after laser resurfacing procedure, this both lubricates the skin and protects against infection (about 5-7days). Vaseline is an alternative that can be used to lubricate the skin.

After this time a light moisturiser (both creams and lotions are fine) are recommended, a hypoallergenic moisturiser such as Cetaphil moisturiser, your skin can be more sensitive at this time and for some people using a regular moisturiser can irritate the skin. If your skin is more sensitive it is fine to continue with Vaseline as this generally very well tolerated.

Cleaning your skin

Cleaning dried and flakey skin appear after several days and it is important to gently cleanse and to clean away debris. You can then complete this with sterile (boiled water) and gentle patting (avoid rubbing your face at this time).

Dr. De Silva uses an erbium laser that tightens superficial skin and reduces the amount of peeling that is seen after CO2 laser resurfacing.

Sun Protection

After 2 weeks you can return to the use of your regular moisturizer and it is important to both avoid sun exposure and use a sunblock (of SPF 30 or above) for 3 months.

Before laser treatment it is important to avoid sun and avoid tanning your skin. For some patients Retin A and hydroquinone can be used for two weeks before laser.

The healing can be enhanced with the use of bio-technology, termed PRP (Platelet rich plasma), this means that your own growth factors are placed in the skin where the laser treatment has been administered, leading to faster healing and less downtime.

Other treatments have been also used in laser after care including vitamin C, Green Tea, glycolic aced and retinoids, however their effectivenss in healing has not been proven.

After laser treatment the older skin will become dry and peel off, during this time there are steps that can be taken to speed up the recovery:

The type of laser and surgical technique, needs to be tailored to the individual the extent of the skin ageing, ethnicity and skin pigmentation. Generally fractionated CO2 lasers offer an effective skin rejuvenation while minimizing the potential side effects and offer a fast recovery. Modern day lasers offer faster recovery by treating only a proportion of the skin (termed fractionated), older lasers treated all of the skin surface (termed ablative lasers) were associated with higher risks and longer recovery. Dr. De Silva utilises state-of-the-art laser machines that result in faster recovery and shorter downtime.

After laser treatment the skin tends to dry out, apply Vaseline or similar lubricating ointment regularly while the skin is crusting and peeling. Keeping the skin moist and regularly cleaned will help a speedy recovery.

Wash your face regularly with a cetaphil skin soap (simple skin soap with few preservatives) to clean the skin from skin debris and body secretions. Cleansing gently with gauze sponges to clean the skin every 3-4 hours is recommended.

After approximately 7-10 days the skin will have finished peeling and you can apply a concealer make up to any areas of the redness.

Depending on the type of laser resurfacing the downtime can vary, most patients are able to return to work with in 7-10 days.

Although a lighter laser resurfacing can be completed with faster recovery, if the treatment is too light it will be less effective. In the same way a spa may offer a “lunchtime peel” with immediate recovery, the results are also likely to be difficult to see. Sun exposure should be minimized for 3-months after laser resurfacing to ensure a fast recovery.

Dr. De Silva uses bio-technology to enhance recovery so recovery time is 10days, Bio-Technology involves the use of PRP (Platelet Rich Plasma) in combination with laser resurfacing to enhancing healing. PRP essentially means taking your own growth factors and placing them into the skin where the laser treatment has been completed, this heals the skin faster.

How common is redness after CO2 laser?

Redness is dependent on patient and treatment characteristics including skin type, type of laser and depth of the laser treatment.

Redness is a common immediately after laser treatment and for the first week after laser. Occasionally there can be redness for up to six weeks and rarely for six months. To reduced the chance of redness several measures can be taken during your laser treatment:

Avoid in certain high risk skin types, identify before treatment

Safety protocol for every patient

Clear post laser resurfacing instructions

Use of bio-technology to enhance recovery after laser

Use of test-patch of laser to avoid risk

An experienced doctor who has used laser resurfacing for many years with good results

State-of-the-art modern laser designed for safety and fast recovery

If you have redness after laser, skin creams can be prescribed that will reduce the redness faster, these include moisturisers, sun block and anti-inflammatory creams. Sometimes your own skin creams including moisturisers can irritate your skin as it can be more sensitive after laser treatment, it may be important to stop using all your regular creams for a period after laser treatment and use hypoallergenic products.

What can I do about lines around my mouth?

Lines around the mouth are often deep and a difficult area to treat. Dr. De Silva considers the following characteristics for treatments around the mouth:

The skin around the mouth is relatively thick and requires different laser settings to be effective. In addition a combination of deep skin resurfacing (CO2 laser) and superficial laser (Erbium laser) can be more effective

Laser resurfacing of this area may need to be coupled with additional treatment such as volume enhancement around the lips. Volume enhancement around the lips can be non-surgical with a hyaluronic acid filler or surgical with fat transfer.

Lines around the mouth are generally more challenging to treat that lines elsewhere on the face and a discussion of realistic expectations from the treatment.

With taking steps to modify the treatment around the mouth, the lines around the mouth can be softened with a combination of deep and superficial laser resurfacing and adding volume to the lip area.

What is the cost of laser resurfacing and why does it vary

The cost of laser resurfacing is dependent on the type of laser, the equipment that is used to complete the procedure, the location and the doctor’s expertise and form of anaesthesia. Modern CO2 and Erbium lasers are advanced machines that use state-of-the-art technology to treat “fractional” areas preserving natural skin that enhances recovery. Dr. De Silva uses dual technology CO2 combined with erbium to target superficial and deep skin. To enhance recovery Fast-Recovery Biotechnology termed PRP (Platelet rich plasma) is used with all patients, this has been termed the “Vampire facelift” in the US and can be used as a treatment on the skin in its own right. CO2 laser is advanced technology that is only completed with trained doctors, the treatment cannot be legally administered by other practitioners in the UK. As a consequence, the total cost varies depending on the technology used, the equipment and the number of treatment sessions.

Is laser resurfacing useful for acne scarring?

Fractional laser resurfacing is an effective treatment for acne scarring. Acne is not cured by laser treatment.

Key to an effective laser treatment are these considerations in acne:

Avoid if treated with Roaccutane in the last 6-months

Postpone if active acne

Realistic expectations for improvement, for acne several treatments may be required, each building on the last

Safety protocol for every patient

Clear post laser resurfacing instructions

Use of bio-technology to enhance recovery after laser

Use of test-patch of laser to avoid risk

An experienced doctor who has used laser resurfacing for many years with good results

Laser resurfacing is only suitable for lighter skin pigmentation, darker ethnicities are not suited to laser resurfacing as there is an increased risk of scarring and darker pigmentation after treatment

Additional treatments may be required to improve acne scarring including the use of volumetric fillers to elevate deep scars. In addition deep scars may require undermining, subcision, punch excision or other surgical techniques to give the best results.

Laser resurfacing is an effective treatment in improving the appearance of the skin and it requires a comprehensive assessment to evaluate the type and severity of acne scarring and if additional treatments are required to enhance the results, and a discussion about expectations from treatment. If you have active acne, prescription medicines may be needed to control acne. It is important to have acne controlled with medications before laser treatment for scars.

What is the difference between Fractional and CO2 lasers?

Older CO2 laser were effective however had longer recovery and downtime with greater chance of redness and pigmentation after treatment.

Fractionated laser are more modern lasers than enhance recovery by sparking portions of the skin to laser. A fractionated laser can be either an Erbium or CO2 laser. Both are effective, the physician who is using it is more important then the actual laser. Fractionated technology is aimed at achieving similar results to standard “resurfacing” with less downtime. Dr. De Silva prefers to use a combination CO2 and Erbium laser, as CO2 laser tightens deeper skin and the Erbium laser tightens more superficial skin.

Recovery can be further enhanced with the use of bio-technology and PRP treatments, that utilise your own growth factors in the area of treatment to enhance recovery.